From film to simulation: Mixed-methods study of learner-driven artificial intelligence-generated ethical dilemma scenarios and role-play to enhance ethical competence in nursing students

초록

Aim: We aimed to develop and implement the Film-Based, Artificial Intelligence (AI)-Generated Interactive Ethical Dilemma Role-Play Simulation program and evaluate its effects on nursing students' biomedical ethics awareness, critical thinking disposition, empathy and program satisfaction. Background: Although AI-based educational tools enhance interactivity and realism, their application in ethicsfocused education remains limited. Design: A mixed-methods design was used with a quasi-experimental nonequivalent control group pretest-posttest element and a qualitative thematic analysis based on structured debriefing data. Methods: The program was developed through literature review, expert consultation, film selection and learnerdriven AI-supported scenario development. Participants were 50 s- and third-year nursing students. The experimental group completed a four-session, two-week program incorporating film viewing, theoretical lectures, critical reflection, learner-driven scenario development supported by AI, role-play and debriefing, whereas the control group only viewed the films. Data were collected from March to April 2025 and analyzed using descriptive statistics, independent t-tests, nonparametric tests and thematic analysis. Results: The experimental group demonstrated significantly greater improvements in biomedical ethics awareness, critical thinking disposition and empathy than the control group. Significant pre-post improvements were also observed. Program satisfaction was high. The qualitative analysis identified three themes: experiencing emotional immersion and empathy, enhancing ethical sensitivity and value reflection and reflecting on the nursing role and strengthening professional identity. Conclusions: The program effectively enhanced ethical awareness, critical thinking and empathy among nursing students. Therefore, integrating film-based learning, AI-generated scenarios and interactive role-play simulations is a feasible and engaging strategy for ethics education.

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